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Health services appraisal and the transition to Medicaid Managed Care from fee for service.

Title

Health services appraisal and the transition to Medicaid Managed Care from fee for service.

Publication Type

Journal Article

2015

Authors

Owen R, Heller T, Bowers A

Journal

Disabil Health J

Date Published

2015 Oct 24

ISSN

1936-6574

BACKGROUND: Many states are transitioning fee-for-service (FFS) Medicaid into Medicaid Managed Care (MMC) for people with disabilities. OBJECTIVE: This study examined managed care's impact on health services appraisal (HSA) and unmet medical needs of individuals with disabilities receiving Medicaid. Key questions included 1) Do participant demographics and enrollment in MMC impact unmet medical needs and HSA? 2) Within MMC, do demographics and continuity of care relate to unmet medical needs? 3) Within MMC, do demographics, unmet medical needs and continuity of care relate to HSA? METHODS: We collected cross-sectional survey data (n = 1615) from people with disabilities in MMC operated by for-profit insurance companies (n = 849) and a similar group remaining in FFS (n = 766) in one state. Regression analyses were conducted across these groups and within MMC only. RESULTS: Across Medicaid groups, MMC enrollment was not related to either HSA or unmet needs; health status, having a mental health disability and unmet transportation needs related to HSA and health status, unmet transportation needs and having a mental health or physical disability related to higher unmet medical needs. Within MMC, in addition to better health and fewer unmet medical needs, less continuity of care significantly decreased HSA. Higher unmet transportation needs, poorer health status, having a physical or mental health disability, and less continuity of care significantly decreased unmet medical needs. CONCLUSIONS: This research points to the importance of meeting unmet needs of individuals in MMC and the need for increased continuity of care as people transition from FFS.

Recently, healthcare systems have changed for Medicaid beneficiaries. In many states, Medicaid coverage is changing from a “fee-for-service” model, to a “Medicaid managed care.” A “fee-for-service” model allows Medicaid agencies to pay doctors directly for services. A “Medicaid managed care” model is one in which payments and services are coordinated through an organization, like a health insurance company. Although managed care can lower healthcare costs and improve coordination between primary-care doctors and specialists, it is unclear how the transition into managed care has affected people with disabilities who receive Medicaid. In this study, we wanted to compare Medicaid beneficiaries with disabilities who had been switched over to managed care with those who had not, to see how satisfied both groups were with their healthcare and whether they were able to get all of their medical needs met through their health plan. We also looked more specifically at the group of Medicaid beneficiaries who had switched to managed care to find out how many people had to change doctors during the transition and if that had an impact on their healthcare satisfaction or unmet medical needs.

What did the researchers do?

We sent surveys to people with disabilities who were eligible for Medicaid in Illinois. More than 1,600 people filled out our surveys. About half of them had been enrolled in a new Medicaid managed care program for about a year before they filled out the surveys, while the other half of respondents were still receiving fee-for-service Medicaid. We asked respondents to tell us how satisfied they were with their healthcare services and whether there were any medical services that they needed but couldn’t get through their health plan. We also asked them some background questions about their age, ethnicity, type of disability, and whether they had problems accessing transportation. Finally, for the group of respondents who had been switched to the managed care health plan, we asked whether or not they had to change some or all of their medical providers.

What did the researchers find?

Respondents in the new managed-care program were about as satisfied with their healthcare as those in the fee-for-service program. They were also equally likely to say that all of their healthcare needs were being met in both programs. However, the managed-care participants reported having more access than the fee-for-service participants to certain services, including dental care, home health, behavioral health counseling, occupational therapy, and dietitian services. The most commonly unmet need was dental care, with about a third of participants across the two groups saying that they did not have access to dental care. In both groups, people who had more health conditions, problems with transportation, or mental-health disabilities reported being less satisfied with their healthcare and were more likely to report having unmet needs.

More than half of the managed-care participants said that they had to change at least some of their providers during the transition, and about a quarter said that they had to change all of their providers. Those participants who could stay with the same providers reported being happier with their healthcare and had less unmet needs than those who had to change some or all of their providers.

How can you use this research?

Medicaid Managed Care can potentially offer high-quality coordinated healthcare for people with disabilities. In fact, access to some services was better under Medicaid managed care than under the older fee-for-service models.

However, if patients have to switch doctors during the transition to managed care, this could have a negative impact on the quality of care they receive. Managed care organizations can reduce this impact by temporarily covering patients’ current providers during the transition.

Some groups of Medicaid beneficiaries are especially at risk for having unmet medical needs, especially those people who have mental-health conditions and those facing transportation barriers. Improving mental-health care and addressing transportation barriers are important areas that require more attention.

A substantial number of Medicaid beneficiaries do not have adequate access to dental care. This is an important problem to address, as proper dental care is linked to the quality of overall healthcare.

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